Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 13.781
Filtrar
1.
BMC Pulm Med ; 21(1): 52, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33546651

RESUMEN

OBJECTIVE: To develop and validate a clinical risk prediction score for noninvasive ventilation (NIV) failure defined as intubation after a trial of NIV in non-surgical patients. DESIGN: Retrospective cohort study of a multihospital electronic health record database. PATIENTS: Non-surgical adult patients receiving NIV as the first method of ventilation within two days of hospitalization. MEASUREMENT: Primary outcome was intubation after a trial of NIV. We used a non-random split of the cohort based on year of admission for model development and validation. We included subjects admitted in years 2010-2014 to develop a risk prediction model and built a parsimonious risk scoring model using multivariable logistic regression. We validated the model in the cohort of subjects hospitalized in 2015 and 2016. MAIN RESULTS: Of all the 47,749 patients started on NIV, 11.7% were intubated. Compared with NIV success, those who were intubated had worse mortality (25.2% vs. 8.9%). Strongest independent predictors for intubation were organ failure, principal diagnosis group (substance abuse/psychosis, neurological conditions, pneumonia, and sepsis), use of invasive ventilation in the prior year, low body mass index, and tachypnea. The c-statistic was 0.81, 0.80 and 0.81 respectively, in the derivation, validation and full cohorts. We constructed three risk categories of the scoring system built on the full cohort; the median and interquartile range of risk of intubation was: 2.3% [1.9%-2.8%] for low risk group; 9.3% [6.3%-13.5%] for intermediate risk category; and 35.7% [31.0%-45.8%] for high risk category. CONCLUSIONS: In patients started on NIV, we found that in addition to factors known to be associated with intubation, neurological, substance abuse, or psychiatric diagnoses were highly predictive for intubation. The prognostic score that we have developed may provide quantitative guidance for decision-making in patients who are started on NIV.


Asunto(s)
Reglas de Decisión Clínica , Intubación Intratraqueal/estadística & datos numéricos , Ventilación no Invasiva , Insuficiencia Respiratoria/terapia , Afroamericanos/estadística & datos numéricos , Anciano , Asma/epidemiología , Estudios de Cohortes , Registros Electrónicos de Salud , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/epidemiología , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Enfermedades del Sistema Nervioso/epidemiología , Neumonía/epidemiología , Trastornos Psicóticos/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Respiración Artificial/estadística & datos numéricos , Insuficiencia Respiratoria/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Sepsis/epidemiología , Accidente Cerebrovascular/epidemiología , Trastornos Relacionados con Sustancias/epidemiología , Insuficiencia del Tratamiento
2.
Int Heart J ; 62(1): 33-41, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33518663

RESUMEN

Although the incidence of acute myocardial infarction (AMI) has been decreasing in the elderly, it has been increasing in the young, especially in Japan. A social impact of AMI would be greater in the young, because loss of the young directly influences social activities such as business, child-raising, and tax payment. The aim of this study was to identify the specific characteristics of young AMI patients. We retrospectively included 408 consecutive AMI patients < 70 years of age, divided into a young group (< 55 years: n = 136) and an older group (55 to < 70 years: n = 272). The prevalence of overweight was greater in the young group (58.5%) than in the older group (40.7%) (P = 0.001). The frequency of current smokers was higher in the young group (67.6%) than in the older group (44.9%) (P < 0.001). Although the prevalence of hypertension was lower in the young group (66.7%) than in the older group (77.2%) (P = 0.017), that of untreated hypertension was greater in the young group (40.4%) than in the older group (27.2%) (P = 0.007). Furthermore, the prevalence of untreated dyslipidemia was greater in the young group (45.0%) than in the older group (26.6%) (P < 0.001). In conclusion, the young AMI patients had more modifiable risk factors such as obesity, smoking, untreated hypertension, and untreated dyslipidemia than the older patients. There is an unmet medical need for the prevention of AMI in the young generation.


Asunto(s)
Infarto del Miocardio/epidemiología , Adulto , Edad de Inicio , Anciano , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
3.
BMC Infect Dis ; 21(1): 116, 2021 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-33494707

RESUMEN

BACKGROUND: The burden of cardiovascular (CV) complications in patients hospitalised for community-acquired pneumonia (CAP) is still uncertain. Available studies used different designs and different criteria to define CV complications. We assessed the cumulative incidence of acute of CV complications during hospitalisation for CAP in Internal Medicine Units (IMUs). METHODS: This was a prospective study carried out in 26 IMUs, enrolling patients consecutively hospitalised for CAP. Defined CV complications were: newly diagnosed heart failure, acute coronary syndrome, new onset of supraventricular or ventricular arrhythmias, new onset hemorrhagic or ischemic stroke or transient ischemic attack. Outcome measures were: in-hospital and 30-day mortality, length of hospital stay and rate of 30-day re-hospitalisation. RESULTS: A total of 1266 patients were enrolled, of these 23.8% experienced at least a CV event, the majority (15.5%) represented by newly diagnosed decompensated heart failure, and 75% occurring within 3 days. Female gender, a history of CV disease, and more severe pneumonia were predictors of CV events. In-hospital (12.2% vs 4.7%, p < 0.0001) and 30-day (16.3% vs 8.9%, p = 0.0001) mortality was higher in patients with CV events, as well as the re-hospitalisation rate (13.3% vs 9.3%, p = 0.002), and mean hospital stay was 11.4 ± 6.9 vs 9.5 ± 5.6 days (p < 0.0001). The occurrence of CV events during hospitalisation significantly increased the risk of 30-day mortality (HR 1.69, 95% CI 1.14-2.51; p = 0.009). CONCLUSION: Cardiovascular events are frequent in CAP, and their occurrence adversely affects outcome. A strict monitoring might be useful to intercept in-hospital CV complications for those patients with higher risk profile. TRIAL REGISTRATION: NCT03798457 Registered 10 January 2019 - Retrospectively registered.


Asunto(s)
Infecciones Comunitarias Adquiridas , Infarto del Miocardio/epidemiología , Neumonía Bacteriana , Anciano , Anciano de 80 o más Años , Femenino , Unidades Hospitalarias , Hospitalización , Humanos , Incidencia , Italia/epidemiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/mortalidad , Prevalencia , Estudios Prospectivos , Factores de Riesgo
4.
Mymensingh Med J ; 30(1): 176-181, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33397871

RESUMEN

Incidence of Myocardial Infarction is increasing day by day in developing countries. Most of the patients who sustain myocardial infarction have coronary atherosclerosis. There are several risk factors for the development of atherosclerosis. Among all the risk factors, vitamin D deficiency has been proposed to play an important role in the development of atherosclerosis. With this aim, a case-control study was carried out to explore the association of serum vitamin D with acute myocardial infarction. The enrolled study subjects were categorized into Group A which comprised of STEMI, Group B, comprised of NSTEMI and Group C comprised of age and sex matched individuals free from acute myocardial infarction. The mean values of serum vitamin D (in ng/ml) were 20.17, 20.8 and 24.77 respectively in STEMI, NSTEMI and control groups. It differed significantly among groups (p<0.001) and it was significantly low in STEMI and NSTEMI groups compared to control group (p<0.001 and p=0.004). From this study it can be concluded that low serum vitamin D is an independent risk factor for developing acute myocardial infarction. Individuals with serum vitamin D <20ng/ml have higher chance of developing acute myocardial infarction compared to those with serum vitamin D >20ng/ml.


Asunto(s)
Infarto del Miocardio , Infarto del Miocardio sin Elevación del ST , Bangladesh/epidemiología , Estudios de Casos y Controles , Humanos , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Factores de Riesgo , Vitamina D
5.
JAMA ; 325(3): 254-264, 2021 01 19.
Artículo en Inglés | MEDLINE | ID: mdl-33464336

RESUMEN

Importance: It is unknown whether angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) have a positive, neutral, or negative effect on clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Objective: To determine whether discontinuation compared with continuation of ACEIs or ARBs changed the number of days alive and out of the hospital through 30 days. Design, Setting, and Participants: A randomized clinical trial of 659 patients hospitalized in Brazil with mild to moderate COVID-19 who were taking ACEIs or ARBs prior to hospitalization (enrolled: April 9-June 26, 2020; final follow-up: July 26, 2020). Interventions: Discontinuation (n = 334) or continuation (n = 325) of ACEIs or ARBs. Main Outcomes and Measures: The primary outcome was the number of days alive and out of the hospital through 30 days. Secondary outcomes included death, cardiovascular death, and COVID-19 progression. Results: Among 659 patients, the median age was 55.1 years (interquartile range [IQR], 46.1-65.0 years), 14.7% were aged 70 years or older, 40.4% were women, and 100% completed the trial. The median time from symptom onset to hospital admission was 6 days (IQR, 4-9 days) and 27.2% of patients had an oxygen saturation of less than 94% of room air at baseline. In terms of clinical severity, 57.1% of patients were considered mild at hospital admission and 42.9% were considered moderate. There was no significant difference in the number of days alive and out of the hospital in patients in the discontinuation group (mean, 21.9 days [SD, 8 days]) vs patients in the continuation group (mean, 22.9 days [SD, 7.1 days]) and the mean ratio was 0.95 (95% CI, 0.90-1.01). There also was no statistically significant difference in death (2.7% for the discontinuation group vs 2.8% for the continuation group; odds ratio [OR], 0.97 [95% CI, 0.38-2.52]), cardiovascular death (0.6% vs 0.3%, respectively; OR, 1.95 [95% CI, 0.19-42.12]), or COVID-19 progression (38.3% vs 32.3%; OR, 1.30 [95% CI, 0.95-1.80]). The most common adverse events were respiratory failure requiring invasive mechanical ventilation (9.6% in the discontinuation group vs 7.7% in the continuation group), shock requiring vasopressors (8.4% vs 7.1%, respectively), acute myocardial infarction (7.5% vs 4.6%), new or worsening heart failure (4.2% vs 4.9%), and acute kidney failure requiring hemodialysis (3.3% vs 2.8%). Conclusions and Relevance: Among patients hospitalized with mild to moderate COVID-19 and who were taking ACEIs or ARBs before hospital admission, there was no significant difference in the mean number of days alive and out of the hospital for those assigned to discontinue vs continue these medications. These findings do not support routinely discontinuing ACEIs or ARBs among patients hospitalized with mild to moderate COVID-19 if there is an indication for treatment. Trial Registration: ClinicalTrials.gov Identifier: NCT04364893.


Asunto(s)
Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Alta del Paciente , Privación de Tratamiento , Anciano , /diagnóstico , Progresión de la Enfermedad , Femenino , Insuficiencia Cardíaca/epidemiología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Oportunidad Relativa , Respiración Artificial/estadística & datos numéricos , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Tamaño de la Muestra , Choque/tratamiento farmacológico , Factores de Tiempo , Resultado del Tratamiento
6.
J Formos Med Assoc ; 120(1 Pt 1): 78-82, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32682701

RESUMEN

Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Infection with SARS-CoV may cause coronary plaque instability and lead to acute coronary syndrome (ACS). Management of ACS in patients with COVID-19 needs more consideration of the balance between clinical benefit and transmission risk of virus. This review provides recommendations of management strategies for ACS in patients with suspected or confirmed COVID-19 in Taiwan.


Asunto(s)
Síndrome Coronario Agudo , Transmisión de Enfermedad Infecciosa/prevención & control , Infarto del Miocardio , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/terapia , /prevención & control , Cardiología/métodos , Cardiología/normas , Comorbilidad , Consenso , Humanos , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Manejo de Atención al Paciente/métodos , Medición de Riesgo , Sociedades Médicas/normas , Taiwán
7.
Angiology ; 72(1): 50-61, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32806925

RESUMEN

To evaluate clinical implication of prediabetes, we compared a 2-year major clinical outcome including patient-oriented composite outcomes (POCOs), stent thrombosis (ST), and stroke between prediabetes and diabetes in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease (MVD). A total of 4097 patients with STEMI and MVD (normoglycemia [group A: 1001], prediabetes [group B: 1518], and diabetes [group C: 1578]) who received drug-eluting stents were evaluated. Patient-oriented composite outcomes were defined as all-cause death, recurrent myocardial infarction (MI), or any repeat revascularization. The cumulative incidences of POCOs, ST, and stroke were similar between groups B and C. The cumulative incidences of all-cause death (adjusted hazard ratio [aHR]: 1.483; 95% CI: 1.027-2.143; P = .036) and all-cause death or MI (aHR: 1.429, 95% CI: 1.034-1.974; P = .031) were higher in group B than in group A. The cumulative incidences of all-cause death (aHR: 1.563; 95% CI: 1.089-2.243; P = .015), cardiac death (aHR: 1.661; 95% CI: 1.123-2.457; P = .011), and all-cause death or MI were higher in group C than in group A. In conclusion, prediabetes could potentially have a similar impact as diabetes on major clinical outcomes in patients with STEMI and MVD.


Asunto(s)
Diabetes Mellitus/epidemiología , Stents Liberadores de Fármacos , Intervención Coronaria Percutánea , Estado Prediabético/epidemiología , Infarto del Miocardio con Elevación del ST/terapia , Factores de Edad , Anciano , Reanimación Cardiopulmonar , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , República de Corea/epidemiología , Estudios Retrospectivos , Infarto del Miocardio con Elevación del ST/mortalidad , Choque Cardiogénico/epidemiología , Accidente Cerebrovascular/epidemiología , Trombosis/epidemiología
8.
Med Care ; 59(1): 6-12, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32925454

RESUMEN

BACKGROUND: US hospitals are penalized for excess 30-day readmissions and mortality for select conditions. Under the Centers for Medicare and Medicaid Services policy, readmission prevention is incentivized to a greater extent than mortality reduction. A strategy to potentially improve hospital performance on either measure is by improving nursing care, as nurses provide the largest amount of direct patient care. However, little is known as to whether achieving nursing excellence, such as Magnet status, is associated with improved hospital performance on readmissions and mortality. OBJECTIVE: The purpose of this study was to examine the relationship between hospitals' Magnet status and performance on readmission and mortality rates for Medicare beneficiaries. RESEARCH DESIGN: This is a cross-sectional analysis of Medicare readmissions and mortality reduction programs from 2013 to 2016. A propensity score-matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. SUBJECTS: The sample was comprised of 3877 hospitals. MEASURES: The outcome measures were 30-day risk-standardized readmission and mortality rates. RESULTS: Following propensity score matching on hospital characteristics, we found that Magnet hospitals outperformed non-Magnet hospitals in reducing mortality; however, Magnet hospitals performed worse in reducing readmissions for acute myocardial infarction, coronary artery bypass grafting, and stroke. CONCLUSIONS: Magnet hospitals performed better on the Hospital Value-Based Purchasing Mortality Program than the Hospital Readmissions Reduction Program. The results of this study suggest the need for The Magnet Recognition Program to examine the role of nurses in postdischarge activities as a component of its evaluation criteria.


Asunto(s)
Hospitales/normas , Medicare , Mortalidad/tendencias , Infarto del Miocardio/epidemiología , Readmisión del Paciente/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/normas , Accidente Cerebrovascular/epidemiología , Estudios Transversales , Hospitales/estadística & datos numéricos , Humanos , Medicare/economía , Medicare/estadística & datos numéricos , Infarto del Miocardio/mortalidad , Alta del Paciente , Readmisión del Paciente/tendencias , Accidente Cerebrovascular/mortalidad , Estados Unidos/epidemiología , Compra Basada en Calidad/organización & administración , Compra Basada en Calidad/normas
9.
BMC Med Inform Decis Mak ; 20(1): 335, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-33317534

RESUMEN

BACKGROUND: Acute myocardial infarction (AMI) is a serious cardiovascular disease, followed by a high readmission rate within 30-days of discharge. Accurate prediction of AMI readmission is a crucial way to identify the high-risk group and optimize the distribution of medical resources. METHODS: In this study, we propose a stacking-based model to predict the risk of 30-day unplanned all-cause hospital readmissions for AMI patients based on clinical data. Firstly, we conducted an under-sampling method of neighborhood cleaning rule (NCR) to alleviate the class imbalance and then utilized a feature selection method of SelectFromModel (SFM) to select effective features. Secondly, we adopted a self-adaptive approach to select base classifiers from eight candidate models according to their performances in datasets. Finally, we constructed a three-layer stacking model in which layer 1 and layer 2 were base-layer and level 3 was meta-layer. The predictions of the base-layer were used to train the meta-layer in order to make the final forecast. RESULTS: The results show that the proposed model exhibits the highest AUC (0.720), which is higher than that of decision tree (0.681), support vector machine (0.707), random forest (0.701), extra trees (0.709), adaBoost (0.702), bootstrap aggregating (0.704), gradient boosting decision tree (0.710) and extreme gradient enhancement (0.713). CONCLUSION: It is evident that our model could effectively predict the risk of 30-day all cause hospital readmissions for AMI patients and provide decision support for the administration.


Asunto(s)
Técnicas de Apoyo para la Decisión , Infarto del Miocardio/terapia , Readmisión del Paciente , Toma de Decisiones Clínicas , Humanos , Modelos Teóricos , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/epidemiología , Alta del Paciente , Medición de Riesgo , Factores de Riesgo , Máquina de Vectores de Soporte , Factores de Tiempo , Resultado del Tratamiento
11.
PLoS One ; 15(12): e0243385, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33362198

RESUMEN

INTRODUCTION: Blacks are more likely to live in poverty and be uninsured, and are less likely to undergo revascularization after am acute myocardial infarction compared to whites. The objective of this study was to determine whether Medicaid expansion was associated with a reduction in revascularization disparities in patients admitted with an acute myocardial infarction. METHODS: Retrospective analysis study using data (2010-2018) from hospitals participating in the University Health Systems Consortium, now renamed the Vizient Clinical Database. Comparative interrupted time series analysis was used to compare changes in the use of revascularization therapies (PCI and CABG) in white versus non-Hispanic black patients hospitalized with either ST-segment elevation (STEMI) or non-ST-segment elevation acute myocardial infarctions (NSTEMI) after Medicaid expansion. RESULTS: The analytic cohort included 68,610 STEMI and 127,378 NSTEMI patients. The percentage point decrease in the uninsured rate for STEMIs and NSTEMIs was greater for blacks in expansion states compared to whites in expansion states. For patients with STEMIs, differences in black versus white revascularization rates decreased by 2.09 percentage points per year (95% CI, 0.29-3.88, P = 0.023) in expansion versus non-expansion states after adjusting for patient and hospital characteristics. Black patients hospitalized with STEMI in non-expansion states experienced a 7.24 percentage point increase in revascularization rate in 2014 (95% CI, 2.83-11.7, P < 0.001) but did not experience significant annual percentage point increases in the rate of revascularization in subsequent years (1.52; 95% CI, -0.51-3.55, P = 0.14) compared to whites in non-expansion states. Medicaid expansion was not associated with changes in the revascularization rate for either blacks or whites hospitalized with NSTEMIs. CONCLUSION: Medicaid expansion was associated with greater reductions in the number of uninsured blacks compared to uninsured whites. Medicaid expansion was not associated, however, with a reduction in revascularization disparities between black and white patients admitted with acute myocardial infarctions.


Asunto(s)
Infarto del Miocardio/epidemiología , Infarto del Miocardio sin Elevación del ST/epidemiología , Intervención Coronaria Percutánea/economía , Infarto del Miocardio con Elevación del ST/epidemiología , Afroamericanos , Anciano , Grupo de Ascendencia Continental Europea , Femenino , Disparidades en Atención de Salud/economía , Hospitalización/economía , Humanos , Masculino , Medicaid , Pacientes no Asegurados , Persona de Mediana Edad , Infarto del Miocardio/economía , Infarto del Miocardio/cirugía , Revascularización Miocárdica/economía , Revascularización Miocárdica/métodos , Infarto del Miocardio sin Elevación del ST/economía , Infarto del Miocardio sin Elevación del ST/cirugía , Pobreza , Estudios Retrospectivos , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/economía , Infarto del Miocardio con Elevación del ST/cirugía , Estados Unidos/epidemiología
12.
Indian Heart J ; 72(6): 541-546, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33357642

RESUMEN

BACKGROUND: COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. METHODS: In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. CONCLUSIONS: This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.


Asunto(s)
/epidemiología , Cardiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Infarto del Miocardio/epidemiología , Pandemias , Admisión del Paciente/tendencias , Sociedades Médicas , Adulto , Comorbilidad , Estudios Transversales , Femenino , Humanos , Incidencia , India/epidemiología , Masculino , Infarto del Miocardio/terapia , Estudios Retrospectivos
13.
Artículo en Inglés | MEDLINE | ID: mdl-33352982

RESUMEN

We investigated patients presenting to emergency departments (EDs) with chest pain to identify factors that influence the use of invasive coronary angiography (ICA). Using linked ED, hospitalisations, death and cardiac biomarker data, we identified people aged 20 years and over who presented with chest pain to tertiary public hospital EDs in Western Australia from 1 January 2016 to 31 March 2017 (ED chest pain cohort). We report patient characteristics, ED discharge diagnosis, pathways to ICA, ICA within 90 days, troponin test results, and gender differences. Associations were examined with the Pearson Chi-squared test and multivariate logistic regression. There were 16,974 people in the ED chest pain cohort, with a mean age of 55.6 years and 50.7% males, accounting for 20,131 ED presentations. Acute coronary syndrome was the ED discharge diagnosis in 10.4% of presentations. ED pathways were: discharged home (57.5%); hospitalisation (41.7%); interhospital transfer (0.4%); and died in ED (0.03%)/inpatients (0.3%). There were 1546 (9.1%) ICAs performed within 90 days of the first ED chest pain visit, of which 59 visits (3.8%) had no troponin tests and 565 visits (36.6%) had normal troponin. ICAs were performed in more men than women (12.3% vs. 6.1%, p < 0.0001; adjusted OR 1.89, 95% CI 1.65, 2.18), and mostly within 7 days. Equal numbers of males and females present with chest pain to tertiary hospital EDs, but men are twice as likely to get ICA. Over one-third of ICAs occur in those with normal troponin levels, indicating that further investigation is required to determine risk profile, outcomes and cost effectiveness.


Asunto(s)
Dolor en el Pecho/epidemiología , Angiografía Coronaria , Servicio de Urgencia en Hospital , Intervención Coronaria Percutánea , Adulto , Australia , Dolor en el Pecho/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/epidemiología , Australia Occidental/epidemiología , Adulto Joven
14.
Kardiologiia ; 60(10): 66-72, 2020 Nov 10.
Artículo en Ruso | MEDLINE | ID: mdl-33228508

RESUMEN

Aim To study long-term compliance with treatment in patients included into the REGistry of pATients after myocArdial infarction (REGATA).Material and methods In 2012-2013, the study included 481 patients with a history of myocardial infarction (MI) who visited the district outpatient clinic. Median age was 72 [62;78] years; men, 51.4 % (n=247); median time from the last MI to the date of inclusion into the registry was 5 [2;9] years. Compliance with treatment was determined with the Morisky-Green questionnaire during telephone contacts with patients at 36 and 48 months (n=230) after the inclusion. Patients scored 4 were considered compliant; patients scored 3 were low-compliant; and patients scored 0-2 were non-compliant. Statistical significance of differences in compliance at 36 and 48 months was assessed with the McNemar test.Results There were no significant differences between the proportions of compliant, low-compliant and non-compliant patients for the analyzed period. However, at 48 months after the inclusion, the number of patients who had difficulties in answering the questionnaire questions significantly increased from 15.5 % to 21.6 % (p=0.04). Analysis of changes in compliance with the treatment for only compliant patients showed that at 36 months from the inclusion, 87 patients remained highly compliant (37.8 %) while at 48 months, only 32 (36.8 %) patients remained compliant with the treatment. Proportion of compliant patients did not significantly differ for men and women, patients younger and older than 60 years, patients with primary MI and reinfarction, prone and not prone to self-management, and for those who used or not the medicine assistance.Conclusion The data obtained as a part of the REGATA registry indicate insufficient long-term compliance with the treatment of after-MI patients with both primary MI and reinfarction, an increasing proportion of patients who are unable to assess their degree of compliance, and decreasing compliance among highly compliant patients during the period between 36 and 48 months of observation. On the whole, there were no significant changes in the compliance with the treatment for 12 months between the first and the second interviews. The proportion of patients compliant with the prescribed drug therapy was significantly lower in the presence of predisposition to self-management.


Asunto(s)
Infarto del Miocardio , Anciano , Femenino , Humanos , Masculino , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/epidemiología , Cooperación del Paciente , Sistema de Registros
16.
Kardiologiia ; 60(9): 55-61, 2020 Oct 14.
Artículo en Ruso | MEDLINE | ID: mdl-33131475

RESUMEN

Aim        To study risk factors (RF) and clinical and anamnestic features of the course and prediction in women with a preserved menstrual cycle and postmenopausal women after ST segment elevation (STEMI) and non-ST elevation myocardial infarction (NSTEMI).Material and methods        This study included 121 women aged 32 to 55 years diagnosed with MI. The patients were divided into two groups, group 1 (study group) consisting of 60 women with preserved menstrual function (1А, STEMI; n=38; age, 48.3±5.7 years and 1B, NSTEMI; n=22; age. 49.0±4.8 years), and group 2 (control) consisting of 61 postmenopausal women (2А, STEMI; n=43; age, 49.05±4.9 years; 2B, NSTEMI; n=18; age, 49.9±3.5 years). Beside the analysis of RF and clinical features, a prediction was produced for each subgroup at one year after discharge from the hospital based on the following indexes: hospitalization for unstable angina, non-fatal MI, revascularization, cardiovascular (CV) death, and major adverse cardiac events (MACE), which included all these outcomes.Results   In all subgroups, the most frequent RFs were arterial hypertension (AH), overweight and obesity, family history, smoking, and type 2 diabetes mellitus (DM2). Among patients with STEMI, smoking was significantly more frequently observed in the group with preserved menstrual function. Oral contraceptives were used by 3 and 6 women of reproductive age in the STEMI and NSTEMI subgroups, respectively. Incidence of STEMI as the onset of ischemic heart disease (IHD, 46.7%) was higher than in subgroup 2A (27.9 %; р=0.003). Early postinfarction angina was a more frequent complication of MI in subgroup 1A than in 2A (р=0.02).Conclusion            The incidence rate of RFs, including AH, overweight and obesity, dyslipidemia, family history, and DM2, was similar in both STEMI and NSTEMI groups. Incidence rate of smoking was statistically significantly higher in subgroup 1A. One-year prediction for women with STEMI and NSTEMI was comparable irrespective of the presence or absence of the menstrual function.


Asunto(s)
Diabetes Mellitus Tipo 2 , Infarto del Miocardio , Adulto , Factores de Edad , Femenino , Humanos , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/etiología , Pronóstico , Factores de Riesgo , Resultado del Tratamiento
19.
Arq. bras. cardiol ; 115(5): 916-924, nov. 2020. tab, graf
Artículo en Portugués | LILACS, Sec. Est. Saúde SP | ID: biblio-1142262

RESUMEN

Resumo Fundamento: O infarto agudo do miocárdio com supradesnivelamento do segmento ST (STEMI) é uma das principais apresentações clínicas da cardiopatia isquêmica. Dados de base populacional são relevantes para entendimento contemporâneo da epidemiologia da doença. Objetivo: Descrever incidência, manejo terapêutico, desfechos clínicos hospitalares e eventos cardiovasculares do primeiro ano de seguimento dos indivíduos hospitalizados por STEMI. Métodos: Estudo de coorte prospectiva de base populacional com registro consecutivo das hospitalizações por STEMI em uma cidade do Sul do Brasil entre 2011 e 2014. Foram incluídos indivíduos com STEMI que apresentaram sintomas de isquemia miocárdica aguda nas últimas 72 horas. Os valores de p < 0,05 foram considerados significativos. Resultados: A incidência anual de hospitalizações por STEMI foi de 108 casos por 100.000 habitantes. A incidência ajustada foi maior entre os mais velhos (risco relativo 64,9; IC95% 26,9 - 156,9; p para tendência linear < 0,001) e entre os homens (risco relativo 2,8; IC95% 2,3 - 3,3; p < 0,001). Ocorreram 530 hospitalizações durante o período avaliado e a taxa de reperfusão foi de 80,9%. A mortalidade hospitalar e a taxa de eventos cardiovasculares em 1 ano foram, respectivamente, 8,9% e 6,1%. Os mais velhos apresentaram maior mortalidade hospitalar (risco relativo 3,72; IC95% 1,57 - 8,82; p para tendência linear = 0,002) e mais eventos cardiovasculares em 1 ano (hazard ratio 2,35; IC95% 1,12 - 4,95; p = 0,03). Conclusão: Este registro demonstra abordagem terapêutica e mortalidade hospitalar semelhante às observadas em países desenvolvidos. Entretanto, a taxa de hospitalizações foi maior comparada com esses países.


Abstract Background: ST-segment elevation myocardial infarction (STEMI) is one of the main clinical manifestations of ischemic heart disease. Population-based data are relevant to better understand the current epidemiology of this condition. Objective: To describe the incidence, therapeutic management, hospital clinical outcomes and cardiovascular events in the first year of follow-up of individuals hospitalized for STEMI. Methods: Population-based prospective cohort study with consecutive registries of hospitalization for STEMI in a city in southern Brazil from 2011 to 2014. It included patients with STEMI who presented acute myocardial ischemia symptoms in the last 72 hours. A p-value < 0.05 was considered significant. Results: The annual incidence of STEMI hospitalizations was 108 cases per 100,000 inhabitants. Adjusted incidence was higher among older individuals (relative risk 64.9; 95% CI 26.9-156.9; p for linear trend < 0.001) and among men (relative risk 2.8; 95% CI 2.3-3.3; p < 0.001). There were 530 hospitalizations in the period under evaluation and the reperfusion rate reached 80.9%. Hospital mortality and the one-year follow-up cardiovascular event rate were, respectively, 8.9% and 6.1%. The oldest patients had higher hospital mortality (relative risk 3.72; 95% CI 1.57-8.82; p for linear trend = 0.002) and more one-year follow-up cardiovascular events (hazard ratio 2.35; 95% CI 1.12-4.95; p = 0.03). Conclusion: This study shows that both the therapeutic approach and hospital mortality are similar to the ones found in developed countries. However, the hospitalization rate was higher in these countries.


Asunto(s)
Humanos , Masculino , Infarto del Miocardio con Elevación del ST/terapia , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio/terapia , Infarto del Miocardio/epidemiología , Brasil/epidemiología , Sistema de Registros , Estudios Prospectivos , Factores de Riesgo , Resultado del Tratamiento , Mortalidad Hospitalaria , Hospitalización
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA